Defining Implementation, Context, and Setting in Research

Implementation, context, and setting are concepts that are widely used and yet have inconsistent definitions and usage in the literature; thus, we present working definitions for each. Implementation is the constellation of processes intended to get an intervention into use within an organization [13 (link)]; it is the means by which an intervention is assimilated into an organization. Implementation is the critical gateway between an organizational decision to adopt an intervention and the routine use of that intervention; the transition period during which targeted stakeholders become increasingly skillful, consistent, and committed in their use of an intervention [14 (link)].
Implementation, by its very nature, is a social process that is intertwined with the context in which it takes place [15 ]. Context consists of a constellation of active interacting variables and is not just a backdrop for implementation [16 ]. For implementation research, 'context' is the set of circumstances or unique factors that surround a particular implementation effort. Examples of contextual factors include a provider's perception of the evidence supporting the use of a clinical reminder for obesity, local and national policies about how to integrate that reminder into a local electronic medical record, and characteristics of the individuals involved in the implementation effort. The theories underpinning the intervention and implementation [17 (link)] also contribute to context. In this paper, we use the term context to connote this broad scope of circumstances and characteristics. The 'setting' includes the environmental characteristics in which implementation occurs. Most implementation theories in the literature use the term context both to refer to broad context, as described above, and also the specific setting.